Women's Information Panel: WM

This module is to be administered to all women age 15 through 49 (see column HL6 of HH listing). Fill in one form for each eligible woman. Fill in the cluster and household number, and the name and line number of the woman in the space below. Fill in your name, number and the date.

WM1. Cluster number _ _ _

WM2. Household number _ _ _

WM3. Woman's name ____

WM4. Woman's line number _ _

WM5. Interviewer name and number____ _ _

WM6. Day/month/year of interview _ _ / _ _ / 2009

WM7. Result of women's interview

Repeat greeting if not already read to this woman:
Good ____! My name is ____ and I am working for Central Statistical Office (CSO). We are working on a nationwide survey concerned with family health and education. You have been selected as one of the respondents to this survey and we would very much appreciate your participation. The interview will take about 30 minutes. All the information we obtain will remain strictly confidential and your answers will never be identified.

If permission is given, begin the interview. If the woman does not agree to continue, thank her, complete WM7, and go to the next interview. Discuss this result with your supervisor for a future revisit.

Interviewer/editor/supervisor notes: use this space to record notes about the interview with this household, such as call-back times, incomplete individual interview forms, number of attempts to re-visit, etc.

WM7A. Was questionnaire administered in privacy?

WM7B. Field editor (name and number):

WM7C. Field supervisor (name and number):

WM7D. Record the time the interview lasted

WM8. In what month and year were you born?

WM9. How old were you at your last birthday?

WM10. Have you ever attended school?

WM11. What is the highest level of school you attended: primary, secondary, or higher?

WM12. What is the highest grade?

WM13. Check WM11:

WM14. Now I would like you to read this sentence to me.

Show sentences to respondent. If respondent cannot read whole sentence, probe: Can you read part of the sentence to me?

WM14A. How long have you been living in (name of current residence)?
If less than one month, record '00' months

WM14B. Just before you moved here, where did you live?
Record name and code type of area.
Probe: Is that a city, town or communal land or resettlement area?
Name of place: _____

WM14C. In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?

WM14D. In the last 12 months, have you been away from your home community for more than one month at a time?

Child Mortality Module: CM

This module is to be administered to all women age 15-49. All questions refer only to live births.

CM1. Now I would like to ask about all the births you have had during your life. Have you ever given birth?

If "no" probe by asking: I mean, to a child who ever breathed or cried or showed other signs of life ? even if he or she lived only a few minutes or hours?

CM2A. What was the date of your first birth?

I mean the very first time you gave birth, even if the child is no longer living, or whose father is not your current partner.

Skip to CM3 only if year of first birth is given. Otherwise, continue with CM2B.

CM2B. How many years ago did you have your first birth?

CM3. Do you have any sons or daughters to whom you have given birth who are now living with you?

CM4 How many sons live with you? How many daughters live with you?

CM5 Do you have any sons or daughters whom you have given birth who are alive but do not live with you?

CM6. How many sons are alive but do not live with you? How many daughters are alive but do not live with you?

CM7. Have you ever given birth to a boy or girl who was born alive but later died?

CM8. How many boys have died? How many girls have died?

CM9. Sum answers to CM4, CM6, and CM8

CM10 Just to make sure that I have this right, you have had (total number) births during your life. Is this correct?

Birth history: BH

Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.
Record names of all the births in bh1. Record twins and triplets on separate lines.

BH1. What name was given to your (first/ next) baby?

BH2. Were any of these births twins?

BH3. Is (name) a boy or girl?

BH4 In what month and year was (name) born?
probe: What is his/her birthday?

BH5. Is (name) still alive?

BH6. How old was (name) at his/her last birthday?
Record age in completed years

BH7. Is (name) living with you?

BH8. Record HH line number of child
Record '00' if child not listed in HH

BH9. If dead: How old was (name) when he/she died?
How many months old was (name)?
Record days if less than 1 month; months if less than 2 years; or years

BH10. Were there any other live births between (name of previous birth) and (name)?

BH11. Have you had any live births since the birth of (name of last birth)?
If yes, record birth(s)

BH12 compare CM9 with number of births in history above and mark:

BH13. Check BH4: did the woman's last birth occur within the last 2 years, that is, since (day and month of interview) in 2007?
If child has died, take special care when referring to this child by name in the following modules.

BH14. At the time you became pregnant with (name), did you want to become pregnant then, did you want to wait until later, or did you want no (more) children at all?

Tetanus Toxoid (TT) module: TT

This module is to be administered to all women with a live birth in the 2 years preceding date of interview.

TT1. Do you have a card or other document with your own immunizations listed?
If a card is presented, use it to assist with answers to the following questions.

TT2. When you were pregnant with your last child, did you receive any injection to prevent him or her from getting tetanus, that is convulsions after birth (an anti-tetanus shot, an injection at the top of the arm or shoulder)?

TT3: If yes: how many times did you receive this anti-tetanus injection during your last pregnancy?

TT4. How many TT doses during last pregnancy were reported in TT3?

TT5. Did you receive any tetanus toxoid injection at any time before your last pregnancy?

TT6. How many times did you receive it?

TT7. In what month and year did you receive the last tetanus injection before that last pregnancy?

TT8. How many years ago did you receive the last anti-tetanus injection before that last pregnancy?

Maternal and newborn health module: MN

This module is to be administered to all women with a live birth in the 2 years preceding date of interview.
Check child mortality module CM12 and record name of last-born child here ____
Use this child's name in the following questions, where indicated.

MN1. In the first two months after your last birth [the birth of name], did you receive a vitamin A dose like this?

Show 200,000 IU capsule or dispenser.

MN2. Did you see anyone for antenatal care for this pregnancy?

If yes: Whom did you see? Anyone else? Probe for the type of person seen and circle all answers given.

MN2A. How many months pregnant were you when you first received antenatal care for this pregnancy?

MN2BB. How many times did you receive antenatal care during this pregnancy?

MN3. As part of your antenatal care, were any of the following done at least once?

MN3A. Were you weighed?

MN3B. Was your blood pressure measured?

MN3C. Did you give a urine sample?

MN3D. Did you give a blood sample?

MN4. During any of the antenatal visits for the pregnancy, were you given any information or counseled about HIV/AIDS?

MN5. I don't want to know the results, but were you tested for the HIV/AIDS as part of your antenatal care?

MN6. I don't want to know the results, but did you get the results of the test?

MN6A. During this pregnancy, did you take any medicine in order to prevent you from getting malaria?

MN6B. Which medicines did you take to prevent malaria?
Circle all medicines taken. If type of medicine is not determined, show typical anti-malaria to respondent.

MN6C. Check MN6B for medicine taken:

MN6D. How many times did you take SP/Fansidar during this pregnancy to prevent malaria?

MN6E. Was it taken in presence of health worker?

MN6H. During pregnancy did you sleep in treated net?

MN7. Who assisted with the delivery of your last child (name)? Anyone else?

Probe for the type of person assisting and circle all answers given

MN8. Where did you give birth to (name)?
If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code.
(Name of place) ____

MN9. When you last child (name) was born, was he/she very large, larger than average, average, smaller than average, or very small?

MN10. Was (name) weighed at birth?

MN11. How much did (name) weigh?
Record weight from health card, if available

MN12. Did you ever breastfeed (name)

MN13. How long after birth did you first put (name) to the breast

If less than 1 hour, record '00' hours. If less than 24 hours, record hours. Otherwise, record days.

Marriage/union module: MA

MA.1 Are you currently married or living together with a man as if married?

MA2. How old was your husband/partner on his last birthday?

MA2A. Besides yourself, does your husband/partner have any other wives?

MA2B. How many other wives does he have?

MA3. Have you ever been married or lived together with a man?

MA4. What is your marital status now: are you widowed, divorced, or separated?

MA5. Have you been married or lived with a man only once or more than once?

MA6. In what month and year did you first marry or start living with a man as if married

MA7. Check MA6:

MA8. How old were you when you started living with your first husband/partner?

Contraception module: CP

CP1. I would like to talk with you about another subject - family planning - and your reproductive health. Are you pregnant now?

CP2. Some people use various ways or methods to delay or avoid a pregnancy. Are you currently doing something or using any method to delay or avoid getting pregnant?

CP3. Which method are you using?

Do not prompt. If more than one method is mentioned, circle each one.

Attitudes toward domestic violence: DV

DV1. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

DV1A. If she goes out with out telling him?

DV1B. If she neglects the children?

DV1C. If she argues with him?

DV1D. If she refuses sex with him?

DV1E. If she burns the food?

DV2. Are you aware of the domestic violence act?

HIV/AIDS module: HA

HA1. Now I would like to talk with you about something else.
Have you ever heard of the virus HIV or an illness called AIDS?

HA2. Can people protect themselves from getting infected with the HIV/AIDS virus by having one sex partner who is not infected and also has no other partners?

HA3. Can people get infected with the HIV/AIDS virus because of witchcraft or other supernatural means?

HA4. Can people reduce their chance of getting the HIV/AIDS virus by using a condom every time they have sex?

HA5. Can people get the HIV/AIDS virus from mosquito bites?

HA6. Can people reduce their chance of getting infected with the HIV/AIDS virus by not having sex at all?

HA7. Can people get the HIV/AIDS virus by sharing food with a person who has aids?

HA7A. Can people get the HIV/AIDS virus by getting injections with a needle that was already used by someone else?

HA8. Is it possible for a healthy-looking person to have the HIV/AIDS virus?

HA9. Can the HIV/AIDS virus be transmitted from a mother to a baby?

HA9A. During pregnancy?

HA9B. During delivery?

HA9C. By breastfeeding?

HA10. If a female teacher has the HIV/AIDS virus but is not sick, should she be allowed to continue teaching in school?

HA10A. If a male teacher has the HIV/AIDS virus but is not sick, should he be allowed to continue teaching in school?

HA11. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the HIV/AIDS virus?

HA12. If a member of your family became infected with the HIV/AIDS virus, would you want it to remain a secret?

HA13. If a member of your family became sick with the HIV/AIDS virus, would you be willing to care for him or her in your household?

HA14. Check MN5: Tested during antenatal care?

HA15. I do not want to know the results, but have you ever been tested to see if you have HIV, the virus that causes AIDS?

HA15A. When was the last time you were tested?

HA16. I do not want you to tell me the results of the test, but have you been told the results?

HA17. Did you, yourself, ask for the test, was it offered to you and you accepted, or was it required?

HA18. At this time, do you know of a place where you can go to get such a test to see if you have the HIV/AIDS virus?

HA18A. If tested for HIV during antenatal care: other than at the antenatal clinic, do you know of a place where you can go to get a test to see if you have the HIV/AIDS virus?

Follow instructions in your interviewer's manual.